{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T13:26:56Z","timestamp":1793798816059,"version":"4.6.1"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,28]],"date-time":"2023-01-28T00:00:00Z","timestamp":1674864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: The role of medication-related osteonecrosis of the jaw (MRONJ) as a dento-maxillo-facial pathology is becoming increasingly important due to its growing prevalence. The success of preventive and therapeutic measures relies mainly on the dentist\u2019s ability to correctly diagnose the disease. Methods: The aim of this study was to evaluate the skills of dental students of different educational levels in choosing the correct stage, diagnostics, and treatment option for MRONJ based on clinical and radiographic imaging (panoramic radiograph, CBCT). The study was designed as a cross-sectional cohort study. Twenty dental students were asked to complete a questionnaire in their third and fifth year of studies in which they had to correctly stage the disease, choose the radiological diagnostics and recommend the treatment. The control group contained experienced oral and maxillofacial surgeons. Results: With an overall performance of 59% (third year: 145.2\/248 points; fifth year: 145.3\/248 points), no statistically significant difference between the educational levels could be observed. The classification based on CBCT imaging was significantly more often correct compared to panoramic radiographs (p &lt; 0.001). Conclusions: This study highlights students\u2019 lack of knowledge in staging, diagnostics, and treatment of MRONJ, even though the CBCT positively affected decision-making. No significant increase in knowledge could be confirmed through clinical education. This study highlights the need for students to catch up on MRONJ diagnostics and treatment planning. Further expansion of teaching in this disease\u2019s context and X-ray diagnostics is needed.<\/jats:p>","DOI":"10.3390\/medicina59020252","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T04:58:25Z","timestamp":1675054705000},"page":"252","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluation of Medication-Related Osteonecrosis of the Jaw (MRONJ) in Terms of Staging and Treatment Strategies by Dental Students at Different Educational Levels"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9899-7715","authenticated-orcid":false,"given":"Diana","family":"Heimes","sequence":"first","affiliation":[{"name":"Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas Alexander","family":"Mark","sequence":"additional","affiliation":[{"name":"Private Praxis Dr. K\u00fchn\u00f6l, Bayreuther Stra\u00dfe 30, 01187 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kuchen","sequence":"additional","affiliation":[{"name":"Institute for Medical Statistics, Epidemiology and Informatics, University Medical Center of the Johannes-Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Pabst","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, R\u00fcbenacherstra\u00dfe 170, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, R\u00fcbenacherstra\u00dfe 170, 56072 Koblenz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomiya","family":"Kyyak","sequence":"additional","affiliation":[{"name":"Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4081-1487","authenticated-orcid":false,"given":"Daniel G. E.","family":"Thiem","sequence":"additional","affiliation":[{"name":"Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Schulze","sequence":"additional","affiliation":[{"name":"Department of Oral Surgery and Stomatology, Division of Oral Diagnostic Science, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1671-3764","authenticated-orcid":false,"given":"Peer W.","family":"K\u00e4mmerer","sequence":"additional","affiliation":[{"name":"Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,28]]},"reference":[{"key":"ref_1","first-page":"e6944","article-title":"Medication-related Osteonecrosis of the Jaw: A Review","volume":"12","author":"AlDhalaan","year":"2020","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jocd.2016.09.005","article-title":"Case-Based Review of Osteonecrosis of the Jaw (ONJ) and Application of the International Recommendations for Management From the International Task Force on ONJ","volume":"20","author":"Khan","year":"2017","journal-title":"J. Clin. Densitom."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.oooo.2014.05.006","article-title":"Osteonecrosis of the jaw in patients treated with oral and intravenous bisphosphonates: Experience in Sweden","volume":"118","author":"Hallmer","year":"2014","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.joms.2013.06.221","article-title":"Osteonecrosis of the jaw in Sweden associated with the oral use of bisphosphonate","volume":"72","author":"Ulmner","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.joms.2009.03.050","article-title":"Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure","volume":"68","author":"Lo","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/S0278-2391(03)00720-1","article-title":"Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: A growing epidemic","volume":"61","author":"Marx","year":"2003","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.joms.2014.04.031","article-title":"American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw\u20142014 update","volume":"72","author":"Ruggiero","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1089\/pho.2014.3742","article-title":"Low-level laser therapy supported surgical treatment of bisphosphonate related osteonecrosis of jaws: A retrospective analysis of 11 cases","volume":"32","author":"Altay","year":"2014","journal-title":"Photomed. Laser Surg."},{"key":"ref_9","first-page":"1741","article-title":"Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5 year experience in the treatment of 131 cases with ozone therapy","volume":"16","author":"Agrillo","year":"2012","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Blatt, S., Kruger, M., Kammerer, P.W., Thiem, D.G.E., Matheis, P., Eisenbeiss, A.K., Wiltfang, J., Al-Nawas, B., and Naujokat, H. (2022). Non-Interventional Prospective Observational Study of Platelet Rich Fibrin as a Therapy Adjunctive in Patients with Medication-Related Osteonecrosis of the Jaw. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030682"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Di Fede, O., Canepa, F., Panzarella, V., Mauceri, R., Del Gaizo, C., Bedogni, A., Fusco, V., Tozzo, P., Pizzo, G., and Campisi, G. (2021). The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168432"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lorenzo-Pouso, A.I., Bagan, J., Bagan, L., Gandara-Vila, P., Chamorro-Petronacci, C.M., Castelo-Baz, P., Blanco-Carrion, A., Blanco-Fernandez, M.A., Alvarez-Calderon, O., and Carballo, J. (2021). Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review. J Clin. Med., 10.","DOI":"10.3390\/jcm10194367"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/j.joms.2022.07.149","article-title":"Re: AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaw-2022 Update","volume":"80","author":"Campisi","year":"2022","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1634\/theoncologist.2010-0183","article-title":"Quality of life implications of bisphosphonate-associated osteonecrosis of the jaw","volume":"16","author":"Miksad","year":"2011","journal-title":"Oncologist"},{"key":"ref_15","first-page":"3527","article-title":"Quality of life in breast cancer patients with bisphosphonate-related osteonecrosis of the jaws and patients with head and neck cancer: A comparative study using the EORTC QLQ-C30 and QLQ-HN35 questionnaires","volume":"32","author":"Kyrgidis","year":"2012","journal-title":"Anticancer Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.coms.2015.06.003","article-title":"The Frequency of Medication-related Osteonecrosis of the Jaw and its Associated Risk Factors","volume":"27","author":"Dodson","year":"2015","journal-title":"Oral Maxillofac. Surg. Clin. North Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.coms.2015.06.008","article-title":"Diagnosis and Staging of Medication-Related Osteonecrosis of the Jaw","volume":"27","author":"Ruggiero","year":"2015","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ctrv.2018.06.007","article-title":"Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases","volume":"69","author":"Otto","year":"2018","journal-title":"Cancer Treat. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/annonc\/mdr039","article-title":"Impact of dental care in the prevention of bisphosphonate-associated osteonecrosis of the jaw: A single-center clinical experience","volume":"23","author":"Vandone","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.job.2019.03.005","article-title":"Medication-related osteonecrosis of the jaw: A literature review","volume":"61","author":"Kuroshima","year":"2019","journal-title":"J. Oral Biosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jormas.2019.10.005","article-title":"Medical students\u2019 knowledge of medication related osteonecrosis of the jaw","volume":"121","author":"Franchi","year":"2020","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"461","DOI":"10.4103\/ejd.ejd_27_17","article-title":"Dental students\u2019 knowledge of medication-related osteonecrosis of the jaw","volume":"11","author":"Rosella","year":"2017","journal-title":"Eur. J. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3421","DOI":"10.1007\/s00520-015-2689-6","article-title":"Knowledge and attitudes of Brazilian dental students and dentists regarding bisphosphonate-related osteonecrosis of the jaw","volume":"23","author":"Brasil","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1111\/j.1365-2753.2009.01203.x","article-title":"Bisphosphonate-associated osteonecrosis of the jaw. Knowledge and attitudes of dentists and dental students: A preliminary study","volume":"16","year":"2010","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.jormas.2018.04.008","article-title":"Medication-related osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain)","volume":"119","author":"Escobedo","year":"2018","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_26","first-page":"e1402","article-title":"Influence of the teaching program on the learning in knowledge and practice of osteonecrosis of the jaws produced by antireasorptives in dental students of the Principality of Asturias (Spain)","volume":"9","author":"Escobedo","year":"2017","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_27","unstructured":"Eisenbei\u00df, C. (2013). Diagnostik der Bisphosphonat-Assoziierten Kiefernekrose Mittels Digitaler Volumentomographie Und Der Panoramaschichtaufnahme im Vergleich, Johannes Gutenberg University Mainz."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.tripleo.2009.12.005","article-title":"Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws","volume":"109","author":"Treister","year":"2010","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1016\/j.joms.2006.05.041","article-title":"Persisting alveolar sockets-a radiologic symptom of BP-ONJ?","volume":"64","author":"Groetz","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.joms.2008.12.002","article-title":"Imaging findings in bisphosphonate-related osteonecrosis of jaws","volume":"67","author":"Arce","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.tripleo.2007.08.040","article-title":"Bisphosphonate-associated jawbone osteonecrosis: A correlation between imaging techniques and histopathology","volume":"105","author":"Bedogni","year":"2008","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_32","unstructured":"Schiegnitz, E., Al-Nawas, B., Hoefert, S., Otto, S., Pautke, C., Ristow, O., Voss, P., and Gr\u00f6tz, K. (2018). S3-Leitlinie Antiresorptiva-Assoziierte Kiefernekrosen (AR-ONJ). AWMF-Register-Nr. 007-091, The Association of Scientific Medical Societies in Germany."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.oooo.2015.11.012","article-title":"Surgical evaluation of panoramic radiography and cone beam computed tomography for therapy planning of bisphosphonate-related osteonecrosis of the jaws","volume":"121","author":"Kammerer","year":"2016","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1259\/dmfr\/27458726","article-title":"Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws","volume":"35","author":"Chiandussi","year":"2006","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/s00784-009-0293-1","article-title":"Panoramic radiograph, computed tomography or magnetic resonance imaging. Which imaging technique should be preferred in bisphosphonate-associated osteonecrosis of the jaw? A prospective clinical study","volume":"14","author":"Stockmann","year":"2010","journal-title":"Clin. Oral Investig."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"667","DOI":"10.7150\/ijms.8.667","article-title":"Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws in an experimental rat model","volume":"8","author":"Cankaya","year":"2011","journal-title":"Int. J. Med. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ristow, O., Schnug, G., Smielowksi, M., Moratin, J., Pilz, M., Engel, M., Freudlsperger, C., Hoffmann, J., and Ruckschloss, T. (2021). Diagnostic accuracy comparing OPT and CBCT in the detection of non-vital bone changes before tooth extractions in patients with antiresorptive intake. Oral Dis.","DOI":"10.1111\/odi.14048"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"20200417","DOI":"10.1259\/dmfr.20200417","article-title":"Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review","volume":"50","author":"Wongratwanich","year":"2021","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_39","first-page":"20170290","article-title":"Does CBCT alter the diagnostic thinking efficacy, management and prognosis of patients with suspected Stage 0 medication-related osteonecrosis of the jaws?","volume":"47","author":"Shimamoto","year":"2018","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jsps.2020.12.012","article-title":"Dental practitioners\u2019 and students\u2019 knowledge of medication related osteonecrosis of the jaw (MRONJ)","volume":"29","author":"Almousa","year":"2021","journal-title":"Saudi Pharm. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e04321","DOI":"10.1016\/j.heliyon.2020.e04321","article-title":"Dentists\u2019 knowledge about medication-related osteonecrosis of the jaw and its management","volume":"6","author":"Alduwayan","year":"2020","journal-title":"Heliyon"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/252\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:18:20Z","timestamp":1760120300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,28]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["medicina59020252"],"URL":"https:\/\/doi.org\/10.3390\/medicina59020252","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,28]]}}}